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CSI > headache > Flashcards

headache Flashcards

1
Q

how many visits/yr

A

13 million visits annually

Brill usually starts with tylenol or ibuprofen

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2
Q

what percentage of ER visits

serious?

A

4%

1%

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3
Q

pathophys: Irritation of pain-sensitive intracranial structures

A

Large arteries
Venous sinuses
Trigeminal nerve (5th cranial nerve)

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4
Q

pain-insensitive structures

A

Choroid plexus
Brain parenchyma
Ventricles ( ependymal lining )
( attributing to little or no headache mass lesions

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5
Q

painful stimuli arising from brain tissue above the tentorium cerebelli are conveyed by the

A

trigeminal nerve

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6
Q

primary

A

Tension-band like
Cluster-in/or around one eye
Migraine-28 million americans
sinus: behind brows

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7
Q

secondary

A 
Stroke
Trauma
Brain lesion
Cocaine
Sinus Disease
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8
Q

migraine ha

A 
Episodic Headache
Associated with 
Gastrointestinal changes*
Neurologic*
Autonomic* 
Unilateral*

One of the three is necessary for the diagnosis ? + 1 phobia

Pulsating; Unilateral
Frontotemporal

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9
Q

migraine sn

A

Phono-phobia Sound sensitivity
Osmo-phobia Odor sensitivity
Photo-phobia* Light sensitivity

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10
Q

migraine timing

A

May begin in childhood- don’t give dx till 5 or 8
Peak ages adolescence and
Young adulthood
Greater in woman then men

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11
Q

aura

A

focal neurologic symptoms precede, accompany, follow(rarely) ha
-develops over 5-20 min
visual disturb.*
-language, sensorimotor, brainstem disturbance

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12
Q

migraine classes

A 
Migraine With aura
Migraine without aura
Hemiplegic Migraine
Confusional Migraine
Ophthalmoplegic Migraine 
Basilar Migraine
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13
Q

complicated migraines usually have..

A

Major neurologic dysfunction
( hemiplegia and coma )
admit*

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14
Q

basilar migraines usually…

A 
Primarily in children 
Episodic headache
Signs of .....
Brainstem dysfunction 
Cerebellar dysfunction  
(Dysarthria, diplopia, ataxia)
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15
Q

aura ddx

A

Seizure

Transient ischemic attack

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16
Q

cluster ha

A 
Intense steady and unilateral
Temporal location (trigeminal cephalgia)  Associated with 
Nasal congestion
Conjunctival injection 
Ipsilateral forehead sweating 
Men > Women 
Late in life onset
Rarely in childhood
Attacks often awaken patients 
“Alarm-clock headache” 
Periods of frequent headaches are separated by headache-free periods of varying duration
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17
Q

tension ha

A 
Most common ( primary )
Pressure feeling
Not unilateral 
Frontal / occipital 
“Pain in the neck”
Pain last for days

band-like

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18
Q

Pseudotumor cerebri

A 
IC hypertension
Worse with straining
Diplopia
Papilledema
Abducens palsy
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19
Q

Pseudotumor cerebri

A

Thrombosis of transverse or sagittal sinus venous thrombosis
Chronic pulmonary disease
SLE
Uremia
Endocrine disorders
Drugs (tetracycline, vitamin A, OCP)
Idiopathic (most common): overweight women age 20-44

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20
Q

imaging

A

Ct brain without contrast to look for space occupying lesion
MRI
MRV

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21
Q

this confirms increased intracranial pressure

A

LP with opening pressure

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22
Q

tx:

A 
Acetazolamide
Topiramate
Prednisone
Weight loss
LP
Shunt
Optic nerve fenestration
Stop causative agent
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23
Q

migraine tx:

A
  1. Acetaminophen
  2. Aspirin
  3. NSAIDs
  4. Opioid ( limited use )-CI: rebound ha
    5.Sumatriptan“triptans” (Serotonin agonist )
  5. Droperidol
    7.Quiet / Dark room
  6. Metoclopramide (Reglan)
    (dopamine interaction )
24
Q

tension tx

A

same + OMM

muscle relaxers: valium, diazepam

25
Q

cluster tx

A
  1. Oxygen
  2. Dihydroergotamine
  3. Sumatriptan
    (Serotonin agonist )
26
Q

secondary

A

SAH
meningitis
mass lesions
intraparenchymal hemorrhage

27
Q

SAH

A 
1 in 10,000 headaches in the United States
1 percent of non traumatic headaches 
 Normal findings   
*Thunder clap*
“ Worst headache of life”   
Onset with exertion 
may have neck pain
28
Q

mass lesion

A

70 % of tumors have “headache” as the initial presenting complaint
-look for brain metastasis

29
Q

meningitis

A 
Viral / Bacterial infection 
Fever 
Nuchal rigidity 
Kernig’s sign ( knee extension )
Brudzinski’s sign ( leg lift )
30
Q

Intraparenchymal Hemorrhage

A

50 % of patients with IPH tumors have “headache” as the initial presenting complaint

31
Q

Critical secondary causes requiring emergent identification and treatment

A
  1. Subarachnoid hemorrhage- need MRI, look for aneurysm
  2. Meningitis-start abx
  3. Brain tumors-increased ICP
    start steroids if not resectables
32
Q

Critical secondary causes not requiring emergent treatment

A

Brain tumor (without increase in ICP)

33
Q

Generally benign and reversible secondary causes

A

Sinusitis
Hypertension
Post-lumbar puncture headache

34
Q

Primary headache

A

Migraine
Tension
Cluster

35
Q

how to tx LP puncture ha

A

typ. tx (NSAIDs, tylenol)
then caffeine
then anesthesia: “blood patch” over LP site, dec. CSF leakage
better when lie flat

36
Q

Ha eval

A 
pattern (worst?)
onset (SAH)
location
assoc. 
meds
comorb
37
Q

assoc. symps

A

Visual changes
Fever
Seizure
Neck stiffness

38
Q

meds that may cause ha

A

nitro

coumadin

39
Q

comorbiditis

A

AIDS-fungal mening., cryptococcal
Malignancies
Coagulopathy-IC hem

40
Q

Physical Exam red flags

A 
Abnormal vitals
Neurological exam
Fundoscopic  exam
Kernig sign
Brudzinski sign
Temporal artery tenderness (scalp
giant cell arteritis, bruits
41
Q

prior hx of ha does not rule out…

and if tx and gets better, does not rule out…

A

serious pathology

same! could still be SAH

42
Q

ha preventiaon

A 
topamax, topiramate?
valproic acid (seizure, mood stab, trig. neuralgia)
candesartan
propanolol
timolol
verapamil
amitriptyline (antidep)
botulinum toxin A 
butterbur-herb
43
Q

ppx for ha that..

A

Headaches that occur more then two or three times a month
Significant disability with attacks
Alteration of central neurotransmission

44
Q

ha ppx

A 
Valproic acid 
Propranolol
Timolol 
Verapamil
Amitriptyline 
Botulinum toxin A
Acupuncture
45
Q

CT scan for….

before LP

A 
Worst headache of life
Abrupt onset
Neurologic deficits 
Persistent vomiting
Fever
Trauma 
Loss of consciousness
Altered mental status
Sinus imaging

HIV
>50 w. normal neuro exam
if abnormal ???

46
Q

get MRI/MRA with

A

Posterior fossa lesion (cerebellar issues)
SAH unable to perform Lumbar puncture
Venous thrombosis
persistent neuro deficit with tx

47
Q

ha management

A

Identify the correct diagnosis of headache
Diminish pain associated with an acute attack
Prevent pain / associated symptoms of recurrent headaches

48
Q

ha diary

A
  • ID triggers
  • monitor frequency
  • involves pt
  • Record response to treatment
49
Q

signs that suggest pathology

A 
Fever 
Nuchal rigidity
Reflex asymmetry
Altered mental status 
Papilledema
50
Q

symptoms that suggest pathology

A 
Worst headache of life
Age over 50
Progressive
Awakens patient-every morning, doesn't go away: mass 
Neurologic dysfunction
51
Q

ddx ha

A

ocular: glaucoma
environmental: high altitude
metabolic: hypoglycemia
toxicology: CO poisoning (cherry red macula, can measure on ABG)
vascular: HTN

52
Q

special pops for has

A

preggos: preeclampsia–>eclampsia: seizure
immcomp: cryptococcal (HIV)

kids: Dental infection
Sinus infection
Neoplasm
Febrile illness

53
Q

read pages 954-958

A

in current

54
Q 
floaters
aura
photophob
norm exam
lay in dark with cold rag
A

UCG

repeat triptan dose
rest, darkness

55
Q

sev. pain around left eye

tearing, congestion

A

cluster

56
Q

sev. pressure-like

worse when bending down, stren activity

A

papilladema
CT, LP
pseudotumor cerebri

CSI (75 decks)

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